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The nine-year-old daughter of Kang XX from Tianjin contracted a warm disease (Wenbing, febrile disease) complicated by sinking of the Great Qi (Daqi, primordial qi residing in the chest) during early autumn.

Etiology She offended her mother and, fearing punishment, hid in a room downstairs. With windows wide open on all sides, she fell asleep on the bed and was exposed to wind, which led to the development of the warm disease.

Symptoms Initially, inappropriate medication caused the pathogenic heat to sink inward, resulting in coma and mutism. After more than twenty days of treatment by multiple Chinese and Western physicians, the condition worsened. Seeing the critical state, doctors declined further treatment. I was then consulted. Her eyes were deviated upward, barely revealing the pupils; her spirit was confused with no perception; her body trembled restlessly; she occasionally emitted belching sounds. Her skin was very hot. Upon opening her mouth, her tongue was retracted and dry, with a thin, slightly yellow coating. When water or rice soup was occasionally administered, she could still swallow. Her respiration was irregular, with intermittent panting. Her pulse beat more than six times per breath (rapid). The left pulse was fine and floating, unresponsive to heavy pressure; the right pulse was wiry and fine, but seemed forceful upon deep palpation. She had not had a bowel movement for ten days.

Diagnosis This is a case where external pathogenic heat has persisted for a long time, burning and consuming the True Yin (Zhenyin, essential yin fluid), leading to liver deficiency. The dryness of Wood (Liver) generates Wind, threatening upward collapse (Shangtuo). Treatment should clear excess heat, nourish True Yin, and be supplemented with sour herbs that astringe the Liver, hopefully saving this critically dangerous condition.

Prescription Raw Gypsum (Shigao, *Gypsum Fibrosum*) 2 liang, ground finely; Wild Taishan Ginseng (Yetaishen, *Panax ginseng* var. *alternum*) 3 qian; Raw Huai Rehmannia Root (Shengdihuang, *Rehmanniae Radix Recens*) 1 liang; Cleaned Cornus Fruit (Jinyurou, *Corni Fructus*) 1 liang; Raw Huai Yam (Shengshanyao, *Dioscoreae Rhizoma*) 6 qian; Licorice Root (Gancao, *Glycyrrhizae Radix et Rhizoma*) 2 qian.

Decoct together to make two large bowls of decoction, taken in three doses at warm temperature. Each dose should be mixed with one raw chicken egg yolk.

Formula Analysis This formula is essentially Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng), substituting Raw Rehmannia for Anemarrhena (*Zhimu*), Raw Yam for Coix Seed/Rice (*Jingmi*), and adding Cornus Fruit. Without Cornus, this is my commonly used formula for treating cold-warm diseases requiring Baihu Jia Renshen Tang in patients with weak constitution and yin deficiency. Here, Cornus is added to astringe the Liver Qi that is about to collapse. Regarding why Baihu Tang modifications are not used, but rather Baihu Jia Renshen Tang modifications are necessary: at this stage of illness, without adding Ginseng to Baihu Tang, it is impossible to retreat the deeply sunk heat and restore the confused consciousness. This principle becomes clear when referring to the medical cases attached to the explanation of Ginseng (*Renshen*).

Second Visit After completing three doses, her eyes no longer deviated upward, her body stabilized and ceased trembling, belching stopped, and respiration became regular. Her spirit was clearer than before, though she still could not speak. Bowel movement remained unpassed, skin remained hot, and pulse rate decreased, no longer as floating and wiry as before, but the right pulse still seemed forceful upon deep palpation. Therefore, slight modifications were made to the original prescription for continued use.

Prescription Raw Gypsum 1.5 liang, ground finely; Wild Taishan Ginseng 3 qian; Raw Huai Rehmannia Root 1 liang; Cleaned Cornus Fruit 6 qian; Asparagus Tuber (Tiantong, *Asparagi Radix*) 6 qian; Licorice Root 2 qian.

Decoct together to make two bowls of decoction, taken in two doses at warm temperature. Each dose should be mixed with one raw chicken egg yolk.

Third Visit One dose was taken daily for two consecutive days. Heat completely subsided. Although mental clarity seemed to be fading and she still could not speak, bowel movement remained unpassed, with occasional signs of straining to defecate. Enema was used to promote bowel movement. On re-examination, all six pulse positions were weak and powerless. It was understood that her inability to speak was due to the sinking of the Great Qi in the chest, preventing it from reaching the root of the tongue. Large-dose tonifying medicines should be used, supplemented with herbs that raise and tonify Qi in the Qi aspect.

Prescription Raw Huai Yam 1 liang; Large Sweet Goji Berry (Dagouqi, *Lycii Fructus*) 1 liang; Glehnia Root (Shashen, *Glehniae Radix*) 1 liang; Asparagus Tuber 6 qian; Ophiopogon Tuber (Cundongdong, *Ophiopogonis Radix*) 6 qian; Raw Arrow Astragalus (Shengjianqi, *Astragali Radix*) 3 qian; Wild Taishan Ginseng 3 qian; Cimicifuga Rhizome (Shengma, *Cimicifugae Rhizoma*) 1 qian; Platycodon Root (Jiegeng, *Platycodi Radix*) 1 qian.

Decoct together to make one and a half bowls of decoction, taken in two doses at warm temperature.

Outcome After taking two doses, she regained the ability to speak. Therefore, Shengma was removed from the original formula, Shashen was halved, and both Cornus Fruit and Raw Barley Sprout (Shengmaiya, *Hordei Fructus Germinatus*) were added at 3 qian each. Several more doses were taken to consolidate recovery.

Commentary Physicians often prefer using Ginseng to rescue conditions of impending collapse. However, Yu Jiayan stated that if Qi is collapsing upward, relying solely on heavy doses of Ginseng may cause Qi to rise uncontrollably; heavy doses of Hematite (*Heshi*, *Hematitum*) must be added to assist for efficacy. This is indeed an immortal truth. In this formula, Ginseng was not used primarily to rescue collapse. Because this condition involves severe depletion of True Yin, only the combination of Gypsum and Ginseng can immediately restore True Yin amidst blazing pathogenic fire. This demonstrates the practical application of Baihu Jia Renshen Tang. As for Cornus Fruit, its power to tonify Qi in the Qi aspect is far inferior to Ginseng, but its ability to rescue upward collapse of Qi far surpasses Ginseng. Indeed, the Liver governs dispersion and excretion. When Yuan Qi (Primal Qi) is extremely deficient, excessive hepatic dispersion often leads to upward collapse. Heavy doses of Cornus astringe the Liver, preventing excessive dispersion, thereby preventing the collapse of Yuan Qi. I have frequently achieved success with this method and am certain of its mechanism.